Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 215157 DEA: 021H5704 EFIS: 0216000036
QA Service Level: 1
DIST-CO-RTE-PM: 02-SHA-299-67.8/77.8
Work Description: BURNEY CAPM - PAVEMENT REHABILITATION
Location Description: BUNCH GRASS LOOKOUT RD TO NAPA LN
Contractor Name: JF Shea Constrcution
Contractor Address: 17400 Clear Creek Road, Redding, CA 96001
Resident Engineer: Kyle Higgins Structure Rep.: Unknown
DIME Sample ID: 2023-09-14-55
TL Number from the TL Form: 857915
Sample Submitted By Organization: CT D02 - Redding Northern Regional Laboratory
Sample Organization Contact: (530) 225-3194
Type of Sample: Department Acceptance
Type of Material: Hot Mix Asphalt
Sample Taken Date: 09/14/2023
Date that the sample was received by the laboratory/organization performing the testing: 09/14/2023
The quantity of what the sample constitutes: 8 Boxes
A brief description of the sample: 3/4" RHMA-G
From where was the sample collected: Manufacturer
Laboratory sample identification: D79347
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: JF Shea Fawndale